Going home

This case shows the importance of respecting a patient’s wishes even if it might not be clinically ideal

Donna, aged 58, had complained intermittently of bloating and abdominal pain for two years.

Her GP prescribed an antispasmodic, mebeverine, and referred her to a dietitian then a gastroenterologist. The latter diagnosed her with irritable bowel syndrome. Her GP did not see Donna again until nearly a year later, when she presented with abdominal swelling.

Clinical examination revealed ascites. Ultrasound confirmed this and showed a pelvic mass. Serum CA125 was markedly elevated at 1000. Donna was referred to a local gynaecologist and then to a gynaecological oncologist.

At laparotomy, extensive tumour deposits were seen over the peritoneum, mesentery and multiple bowel loops. A total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. Residual tumour nodules were all <0.5cm in diameter, implying optimal tumour debulking.

Histology showed typical